Understanding knowledge of hepatitis B in migrant communities to inform national strategies

Published on the 26 February 2026

The survey explored attitudes towards testing and people living with hepatitis B, connections to community and trust in Western medicine. Photo: Adobe Stock images.

New research on harder-to-reach groups will inform hepatitis B testing, prevention and links to care.

UNSW research examines attitudes, beliefs and knowledge of hepatitis B to promote more targeted interventions for Chinese, Vietnamese, Filipino and Korean communities.

The Australia-first national survey study from the UNSW Centre for Social Research in Health (CSRH) explores attitudes towards testing and people living with hepatitis B as well as connections to community and trust in Western medicine among communities with high prevalence.

Participants demonstrated inconsistent knowledge of hepatitis B and lower levels of understanding of its causes across all four groups, says lead researcher Professor Loren Brener.

Almost all Filipino participants (96.5%) and most other participants (86.5%-90.3%) had received some information on hepatitis B with the most common source being the internet, the research found.

“While the majority of participants from all groups knew hepatitis B was caused by a virus, about one-third of all participants incorrectly attributed the cause to unrelated conditions,” the expert on stigma experienced by people living with blood-borne viruses says.

These included working too hard, physical exhaustion and fatigue, contaminated food, water or utensils, drinking too much alcohol, poor sanitation and hygiene, stress and negative emotions, and a damaged liver/weak liver.

Vietnamese participants appeared to have better knowledge about hepatitis B in general, with 85% aware there was a vaccination to prevent it while Filipino participants had the least knowledge of the surveyed groups with only 63% aware of vaccination, the study found.

“The findings highlight the importance of understanding the differences among these migrant communities so that health promotion and stigma reduction interventions can be appropriately tailored to the relevant community,” Prof. Brener says.

The study represents the first research on hepatitis B with Korean and Filipino communities in Australia. “As migrants, these communities have so many other issues to face when they come here, healthcare can rank quite low,” she says.

“Exploring how hepatitis B is understood and attitudes towards it and Western medicine can help us to raise awareness, to reach these communities to get people vaccinated, tested and diagnosed.

“This will help inform national strategies for more positive health outcomes, including preventing coinfection with hepatitis D which is a highly problematic, difficult to treat disease.”

The project, funded by the Australian Government Department of Health, surveyed 997 Chinese, 966 Vietnamese, 579 Filipino and 599 Korean adults. Almost all Korean participants (98.8%) and most Chinese participants (89.1%) were born outside Australia; 77.4% of Vietnamese participants and just less than half the Filipino participants (48.1%) were born outside Australia. The study also surveyed 110 participants living with hepatitis B.

Participants were asked about their understanding and experience of hepatitis B, including testing, vaccination status and health-seeking behaviours.

The study was conducted in partnership with Multicultural Health and Support Service (MHSS) in Victoria, Hepatitis NSW, Hepatitis SA, Hepatitis WA, Ethnic Communities Council of QLD (ECCQ) and LiverWELL in Victoria.

Working with and for migrant communities

The research was guided by an advisory group comprised of hepatitis and multicultural organisations and researchers from most of Australia’s states and territory.

The project also drew on the expertise of researchers from the identified backgrounds to adapt the surveys and input hard-copy data; “capturing the cultural nuance and ensuring a culturally appropriate approach was vital,” Prof. Brener says.

The project used both hard copy and online surveys with recruitment at community events facilitated by partner organisations. Online recruitment was undertaken nationally via social media with surveys distributed via targeted social media sites by researchers of Chinese, Vietnamese, Filipino and Korean backgrounds.

Participants had the choice of completing the survey in traditional or simplified Chinese, Vietnamese, Tagalog, Korean or English. “This personalised approach through community was key to the success of the project.”

Most of the participants reported feeling some connection with their community, with more than half of all four communities reporting they have ‘quite a bit’ or ‘a lot’ in common with their cultural community, the research found.

By contrast, there was mixed and inconsistent trust in Western medicine. Korean participants appeared to show the greatest trust in Western medicine with the Filipino participants showing the most distrust.

38% of Filipino participants, 19% of Chinese and Vietnamese participants and 12% of Korean participants reported they were unwilling to speak with Western-trained doctors and healthcare workers in detail on their health and disease treatment.

The research team is currently investigating attitudes and knowledge of hepatitis B amongst people from the sub-Saharan African and Middle East and North African communities. Photo: Supplied.

Experiences of stigma in relation to hepatitis B

The research revealed mixed attitudes towards hepatitis B with the Filipino participants reporting the most negative attitudes towards people living with hepatitis B. “We found once again in our research that attitudes and knowledge are very closely linked,” Prof. Brener says.

“While the majority of all participants felt that people who have hepatitis B should not be isolated by family and friends, approximately one third of all four migrant groups reported that if they knew that someone had hepatitis B, they would avoid close contact with them, for example, shaking hands or hugging.”

In addition, more than half the participants felt screening or testing for hepatitis B is necessary for job applications because it’s helpful for preventing transmission to other employees.

Participants living with hepatitis B were asked questions around disclosure of their hepatitis B to others. Participants had most commonly disclosed to immediate family, sexual/intimate partners and doctors.

“Some of the concerns around telling someone they had hepatitis B were being isolated, being afraid of losing a study opportunity at school or university, and worrying about being blamed for having hepatitis B.”

Examples of some more negative attitudes were: 64% of Chinese participants agreed/strongly agreed they wouldn’t have a romantic relationship with someone who has hepatitis B; 49% felt people who have hepatitis B should minimise their participation in public activities; 28% of Filipino participants felt people who have hepatitis B should be ashamed of themselves; 33% of the Vietnamese sample felt people who have hepatitis B deserve it.

“Targeting these negative attitudes will help support people living with hepatitis B and promote stronger pathways to health care.”

Already the research is being used by Hepatitis NSW to inform interventions, particularly for the Filipino communities, with strong interest from community groups and organisations.

“The research constitutes a missing piece in our work on stigma among people affected by blood borne viruses,” Prof. Brener says.

“It responds to the need for more qualitative data on these communities to understand how they engage with Australian healthcare, which can be cumbersome to navigate [even without cultural and linguistic barriers].”

The study is part of a larger research project measuring experiences and expression of stigma and discrimination targeted at people affected by blood borne viruses and sexually transmissible infections.

The Stigma Indicators Monitoring study aims to develop a suite of measures to monitor stigma among priority populations in Australia, as identified in the five Australian national strategies focussing on HIV, hepatitis B, hepatitis C and sexually transmissible infections.

Priority populations include men who have sex with men, people who inject drugs, people living with HIV, people living with viral hepatitis (B and C) and people who engage in sex work.

Accessing sub-Saharan African (SSA) and Middle East and North African (MENA) communities

The research team is currently investigating attitudes and knowledge of hepatitis B amongst people from the sub-Saharan African and Middle East and North African communities. Aside from its English version, the survey was translated into Arabic, Swahili and French, reaching around 700 participants.

These groups are under-represented in hepatitis B research, Chief Investigator Dr Sylvester Okeke from CSRH says. “Australia is a complex country with regard to ethnicity, but no group is hard to reach; it’s just not having the right research design.”

The study was driven by researchers from each migrant group. Dr Okeke travelled with the survey in his bag so he could engage community members he met, engaging in casual chats.

Participants discussed obstacles to accessing health care, including a lack of trust, institutionalised and casual racism and structural violence, often as part of their daily experience.

“Trust is never about doubting the efficacy of orthodox or Western medicine. The [dis]trust is more in the process. Trust is not about the person; but more about the system.” This is more than perceived or anticipated stigma, it’s the belief others hold negative attitudes toward your migrant group, he says.

“Where a white person asking for their rights in a health service is being ‘assertive’; a black person doing the same is being ‘aggressive’. The same action being interpreted differently. The issue is in the system,” he says.

“I don't just talk as a researcher, I talk as a community member who’s experienced this firsthand; from accessing health care to navigating the education system, the world of work, public transport and even shopping – it’s entrenched.

“But when we involve community members in non-tokenistic ways, research and interventions become empowering because everyone is involved.

“Here at CSRH, we strive to meet our obligations and are guided by the global approach of never leaving anyone, any community, behind in our response to these health challenges.”